The purpose of this research is to explore colorectal cancer screening utilization and delivery patterns as well as the underlying decision processes driving these patterns. Decisions surrounding colorectal cancer screening are complex and involve many perspectives. Physicians face multiple screening strategies without a clear consensus as they seek to balance clinical accuracy with factors that influence patient compliance in situations further complicated by differing health plan coverage levels. Patients face barriers to seeking cancer screening that are both pragmatic and personal in nature. The simultaneous understanding of physician and patient decision processes is essential to improve the quality of care. The proposed research focuses on health services utilization and delivery in a cross-sectional sample of residents of the state of Kentucky. Further, focused analyses of high-risk and underserved populations - Medicaid members and residents of Appalachia - as they are less likely to obtain colorectal cancer screening and experience consequences which are significantly more dire than the general population, both in terms of morbidity and mortality, is proposed. The Specific Aims are threefold: (1) to investigate the impact of colorectal cancer screening decisions on a high-risk population; (2) to develop models of patient and physician decision processes; and (3) to determine the predictive validity of the patient decision model through a survey of a high-risk population. To address these aims, a mixed-method design incorporating secondary data analysis, interviews techniques and surveys is proposed. Key research questions guiding this research include: What is the trend of colorectal screening utilization and delivery over time? How frequently does Medicaid enrollment coincide with colorectal cancer diagnosis? How is screening strategy related to health outcome? What factors predict health outcome? What risks, barriers, and benefits do patients and physicians consider while making colorectal cancer screening decisions? How do demographic, psychosocial, colorectal cancer-specific knowledge and health care system factors influence the outcome of patients' decision processes? This research will identify, opportunities for behavioral interventions designed to improve patient and physician decisionmaking regarding colorectal cancer screening.